Department of Behavioral Health & Developmental Disabilities Board of Directors Budget Presentation FY 2012 Amended, FY 2013 Commissioner Frank E. Shelp, M.D., M.P.H. August 22, 2011
Budgetary Environment • The State of Georgia is continuing to experience budgetary pressures due to the recession. • The Governor’s Office of Planning & Budget has instructed most state agencies to propose budget cuts in the amount of 2% for Amended FY2012 and FY2013. • In contrast to previous years, DBHDD will not be fully exempted in this budget cycle. • Consequently, the department is anticipating cuts in the amount of $6.0M - $13.4M for Amended FY2012 and FY2013 depending on OPB guidance. 2
FY 2012 Base Budget State Federal & Total Other Department of Behavioral Health & $893,724,585 $255,340,274 $1,149,064,859 Developmental Disabilities Community $570,364,256 $153,017,602 $723,381,858 Hospital $286,668,079 $87,851,689 $374,519,768 Administration $33,269,230 $4,778,089 $38,047,319 Consumer Transportation $2,600,000 $7,265,270 $9,865,270 Attached Agencies $823,020 $2,427,624 $3,250,644 3
AFY 2012 and FY 2013 Priorities • Comply with the DOJ Settlement Agreement by expanding and improving community services • Comply with Olmstead & CRIPA mandates • Address growing Forensic Services challenges 4
Requested Changes to State Funds Budget AFY 2012 FY 2013 New Community Services (ex waivers) - $30,253,760 Additional DD Waivers (including - $16,214,004 waivers for DFCS youth) Forensic Initiatives - $13,730,000 Metro Atlanta Emergency Svcs Center - $11,584,960 FMAP Rate Adjustment - $7,166,955 2% Reduction ($13,471,381) ($13,434,317) 5
Mental Health Community Initiatives 1. New community services for 9,000 individuals with serious and persistent mental illness (SPMI) by 2015 2. Crisis services 3. Accountability and control 4. Maximize Medicaid funding 6
1. New Community Services for 9,000 Individuals with SPMI (1 of 2) FY 2013 A. Assertive Community Treatment (ACT) Teams 2 additional teams (New Total: 22 Teams) $476,740 B. Community Support Teams (CST) 2 new teams (New Total: 4 Teams) $559,368 C. Intensive Case Management (ICM) 1 new team (New Total: 3 Teams) $395,703 D. Case Management (CM) 10 case managers (New Total: 15 Case Managers) $135,993 7
T eam Compositions A. Assertive Community Treatment (ACT) • 10 team members • 1 to 10 staff to client ratio A. Community Support Team (CST) • 3 team members including case manager, peer support and nurse • 1 to 20 staff to client ratio in rural areas • 1 to 30 staff to client ratio in urban areas B. Intensive Case Management (ICM) • 10 FTE case managers to 1 FTE supervisor • 1 to 20 staff to client ratio in rural areas • 1 to 30 staff to client ratio in urban areas C. Case Management • 1 to 50 staff to client ratio 8
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1. New Community Services for 9,000 Individuals with SPMI (2 of 2) FY 2013 E. Housing Supports/Rental Subsidies Assistance to 1,076 individuals w/o other housing benefits $2,203,450 F. Peer Supports 535 individuals served by certified peer specialists $957,543 G. Discharge/Transition Planning Supports for individuals transitioning from institutions $475,000 H. Supported Employment Supports for 440 individuals $997,317 I. Consumer Transportation Round trip transportation of consumers to employment, services, $3,242,631 and treatment 10
2. Mental Health Crisis Services FY 2013 A. Mobile Crisis Services – Dispatch & Response Increase crisis line capacity for statewide service $1,421,000 B. Mobile Crisis Response Services Expand & improve statewide mobile crisis services $3,745,372 C. Crisis Stabilization units (CSUs) 1 new 16-bed program by FY13 $2,000,000 D. Crisis Services Center 1 new facility by FY14 – Start Up Costs Needed in FY13 250,000 11
3. Accountability & Control FY 2013 A. Quality Management Program Provider auditing; service & cost monitoring; performance reporting & $2,459,160 outcome monitoring B. Enhanced Regional Monitoring Enforcement of corrective action plans; Olmstead planning and $1,339,521 assurance; resource management; provider technical assistance C. Community Information & Financial Systems New community information system for outcome reporting and $1,500,000 monitoring; integrated financial system D. Training Provider training in evidence-based practices $250,000 12
New Community Services Mental Health & Quality Management FY 2013 A. ACT/CST/ICM/CM Teams $1,567,804 B. CSP’s & Community Hospital Beds $2,000,000 C. Crisis Line, Mobile Crisis Services, & Crisis Svc Center $5,416,372 D. Supported Housing & Supported Employment $2,570,767 E. Peer Support Services $957,543 F. Provider Training $250,000 G. ACT Monitoring, Quality Management, & Network Analysis $5,298,681 H. Transition Planning $475,000 I. Housing & Residential Support Services $630,000 J. Consumer Transportation $3,242,631 ANNUAL TOTAL $22,408,797 13
Developmental Disabilities Community Initiatives 1. Mobile crisis and crisis respite with medical/nursing services 2. Family supports 3. Expanded waiver services 14
Developmental Disabilities Community Initiatives Detail FY 2013 1. Mobile Crisis & Crisis Respite with Medical/Nursing Services 9 crisis respite homes (24/7) and 6 mobile crisis teams to eliminate all $5,122,963 DD hospital admissions 2. Additional DD Waivers Additional 250 waivers (150 for hospital transition, 100 wait list) $8,969,943 Annualize 250 FY 11 waivers (150 for hospital transition, 100 wait list) $5,944,066 Annualize waivers for youth aging out of DFCS care $1,299,996 3. Family Supports Supports 1,350 families in keeping children at home and avoiding more $1,872,000 costly services 4. Education & Audits Audit community providers of waiver services & provide education to $850,000 community partners 15
Forensic Services - Current Situation 1. The Department has a Forensic Services Capacity of 590 beds. 2. There are 122 individuals on the wait list (88 in jail, 24 on bond). 16
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Forensic Services - Rates of Mental Health Hospitalization vs Prison System Aggregate rate of institutionalization per 100,000 adults (1934 – 2000) and disaggregated trend lines for mental hospitalization and state/federal prisons Nationally, 56% of inmates in state prisons reported mental health problems in the past year Census Bureau, Department of Health and Human Services, and Bureau of Justice Statistics “ The Mentally Ill Behind Bars” by Bernard E Harcourt The NY Times January 15, 2007 18
Forensic Services - New Initiatives Project in Priority Order FY 2013 1. Fulton County Diversion Project $750,000 2. Additional 40 Bed Unit in Atlanta $5,600,000 3. Forensic Supervised Apartments $2,130,000 4. Community Integration Homes $2,800,000 5. Floating Forensic Evaluators $450,000 6. Court Diversion $2,000,000 ANNUAL TOTAL $13,730,000 19
Forensic Services - Long T erm Solution (1 of 2) 1. Consolidate forensic inpatient locations 2. Construct 2 new facilities One facility to be on the grounds of GRHA 3 Locations instead of 6 to improve efficiency Better design to further improve efficiency, enhance safety, and reduce maintenance costs Locations will be closer to the department’s areas of greatest need 20
Forensic Services - Long T erm Solution (2 of 2) 1. Both facilities will be constructed with capital funding FY2013 Costs: $79,699,938 21
Metro Atlanta Emergency Psychiatric Services Center (1 of 3) 1. The Emergency Services Center will: Eliminate congestion in area emergency rooms Reduce demand on state hospital services 3. The Emergency Services Center will have three levels of care providing 24 hour services: Lobby/Admissions 23 Hour Observation (32 Beds) Inpatient Unit (15 Beds) 22
Metro Atlanta Emergency Psychiatric Services Center (2 of 3) 1. Staffing will consist of: HST: 5 per shift Social Worker: 4 per shift RN: 3 per shift LPN: 2 per shift Psychiatrist: 3 per shift Behavioral Support Specialist: 9 per shift 23
Metro Atlanta Emergency Psychiatric Services Center (3 of 3) FY 2013 1. Staffing $8,078,563 2. Overhead (Excluding Medication) $2,019,641 3. Medications $514,650 4. Discharge Medications $164,250 5. Administration $807,856 ANNUAL TOTAL $11,584,960 24
Required 2% Reduction State Funds Impact by Division (in millions) Division AFY 2012 FY 2013 1. Addictive Diseases ($0.5) ($0.5) 2. Developmental Disabilities ($2.9) - ($6.8) ($2.9) - ($6.7) 3. Mental Health ($2.6) - ($6.2) ($2.6) - ($6.2) ANNUAL TOTAL ($6.0) - ($13.5) ($6.0) - ($13.4) 25
Proposed FY 2012 Amended Budget State Federal & Total Other Department of Behavioral Health & $880,253,204 $255,340,374 $1,135,593,478 Developmental Disabilities Community $556,892,875 $153,017,602 $709,910,477 Hospital $286,668,079 $87,851,689 $374,519,768 Administration $33,269,230 $4,778,089 $38,047,319 Consumer Transportation $2,600,000 $7,265,270 $9,865,270 Attached Agencies $823,020 $2,427,624 $3,250,644 26
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